Provider Demographics
NPI:1053622357
Name:POEHLER, SHAUN JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:JAMES
Last Name:POEHLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-4928
Mailing Address - Country:US
Mailing Address - Phone:618-719-3180
Mailing Address - Fax:
Practice Address - Street 1:201 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3901
Practice Address - Country:US
Practice Address - Phone:618-339-6250
Practice Address - Fax:618-545-9682
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor